European Journal of Biomedical and Pharmaceutical Sciences

THE RELATIONSHIP BETWEEN INFLAMMATORY BOWEL DISEASE, CARDIOVASCULAR RISK FACTORS, AND OUTCOMES: AN UMBRELLA REVIEW

Iman Zahedi, Kholood Ahmad, Mark Majid Haddad*, Aqsa Latif, Ezrah Chukwunonso Onyejide, Sourav Deb Raj, Winifred Iklaki7, Akpevwoghene Erhiano, Jashanpreet Singh Ballagan, Sahar Ansar, Shilpa Rai, Madiha Haseeb, Javier Isaac Solorzano Leon, Omolola Okunromade and Amy Alfy

ABSTRACT

Background: Inflammatory bowel disease (IBD) affects nearly 5 million individuals worldwide, with increasing incidence and prevalence over the past few decades. Emerging evidence suggests an association between IBD, and cardiovascular diseases (CVD), potentially due to shared inflammatory pathways and immune-mediated mechanisms. However, existing systematic reviews and meta-analyses investigating this association have yielded inconsistent results. We conducted an umbrella review to systematically assess and synthesize the available evidence on the relationship between IBD and cardiovascular factors. Methods: We adhered to the PRISMA Statement 2020 guidelines and performed a comprehensive literature search in PubMed, Web of Science, and Scopus. We included systematic reviews and meta-analyses published in peer-reviewed journals that investigated the association between IBD, cardiovascular risk factors, and CVD. Data extraction was performed using a standardized form, and we conducted a narrative synthesis of the included studies, focusing on the associations between IBD, cardiovascular risk factors and outcomes. Results: Our search identified nine studies, which reported an increased risk of adverse cardiovascular outcomes, including myocardial infarction, stroke, heart failure, and thrombotic events among IBD patients compared to non-IBD controls. IBD patients demonstrated increased arterial stiffness and endothelial dysfunction. However, the primary studies within these reviews were mainly observational. The JBI appraisal scores of the included studies ranged from 4 to 9; the majority of the included studies had high or moderate JBI Appraisal Scores, suggesting that the overall quality of the evidence was relatively good. The findings from these studies were more likely to be reliable and can be used to inform evidence-based decision-making in healthcare. However, the lower-quality study (score: 4) should be carefully considered and corroborated with additional research before drawing any strong conclusions. Conclusion: This umbrella review provides strong evidence for an association between IBD and increased cardiovascular risk/associated CVD outcomes. Further research is needed to elucidate the underlying mechanisms, identify potential risk factors, and develop effective prevention and management strategies for IBD patients. Future studies should investigate the role of IBD treatments, disease duration, and severity on cardiovascular outcomes, as well as explore the potential interactions between IBD and other cardiovascular risk factors.

Keywords: Inflammatory bowel disease; Cardiovascular factors; Umbrella review; Crohn's disease; Ulcerative colitis; Cardiovascular risk; Thrombotic events; Inflammation.